Quick Response Grant Application Form

= Required Fields

APPLICATIONS MAY BE SUBMITTED AT ANY TIME

The Shire of Northam invites applications for funding to support innovative responses to community needs, either as a whole or target groups (children, youth, seniors, persons with a disability, culturally or linguistically diverse). Grants of up to $500 are intended to assist the delivery of urgent projects or to assist in the delivery of programs/events for which short term opportunity/need has arisen.

Applications will be assessed against the assessment criteria and within six weeks of receipt of application.

ELIGIBILITY

The project must take place within the Shire of Northam or significantly benefit the Shire of Northam community.

The project must address a clearly identified need and the funding can be utilised for venue hire, equipment hire and promotion.

Consideration will not be gived to the following:

Retrospective funding

Recurrent salaries or operational costs not directly associated with the funded event/project

Gifts

Equipment purchases or capital projects unless there is demonstrated risk to safety or well being

Applicants that have outstanding acquittals

Applicants that have previously received funding through this program within the same financial year

ASSESSMENT CRITERIA

Applications will be assessed against the following criteria:

Demonstration of community need and urgency

Anticipated outcomes in response to identified need

Evidence of other support/funding

Recognition of Shire of Northam support

APPLICATION REQUIREMENTS

In order to be considered for funding applicants must provide the following:

Completed application form

Copy of Public Liability Insurance (where applicable)

Copy of certified organisational financial statements

QUESTIONS

Enquiries regarding eligibility and the application process should be directed to:

I herby certify that I have been authorised to prepare and submit this application, and that the information herein is, to the best of my knowledge, true and correct.Should financial assistance be provided by the Shire of Northam, the applicant agrees to the following conditions of funding:1. The financial contribution from the Shire of Northam is not retrospective - funding will not be provided if the event/project commences prior to Shire approval.2. The financial assistance will be used only for the purposes for which it is granted, unless otherwise agreed in writing by the Shire of Northam.3. The Shire of Northam will be advised of any change in scope of the project and the Shire of Northam retains the right to refuse/reduce its level of financial assistance in that instance.4. Funding will be expended within six months of receipt of grant offer.5. Unspent funds are to be returned to the Shire of Northam within 3 months of event/project date/end of grant term.6. If special conditions are applied as a condition of funding, the applicant will be required to agree in writing to these conditions prior to the financial assistance being provided.7. The applicant will acknowledge the Shire of Northam's support in all public communications relating to the event/project, including signage, advertising and promotional materialsin accordance with Shire requirements.8. The applicant will provide a full acquittal of all funds, including project evaluation and evidentiary materials as required by the Shire of Northam within three months of the end of the grant term.